Inspection on 25/09/08 for Brick Barn Residential Home

This inspection was carried out on 25th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brick Barn Residential Home 11/07/08

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Brick Barn Residential Home 106 Walton Road Kirby Le Soken CO13 0DB The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Pauline Dean Date: 2 5 0 9 2 0 0 8 Information about the care home Name of care home: Address: Brick Barn Residential Home 106 Walton Road Kirby Le Soken CO13 0DB 01255673232 01255673232 brickbarn@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Brick Barn Care Home Ltd Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category 16 0 Over 65 0 16 Conditions of registration: The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 16 Date of last inspection Brief description of the care home Brick Barn provides care for up to 16 elderly people. People living at the home have a diverse range of needs associated with their age, mental and physical health. The accommodation is provided in a period property located in a small Essex village between Colchester and Clacton-on-Sea. The home has a large well maintained garden Care Homes for Older People Page 2 of 13 area that is easily accessible. The village has a local shop and public house. The entrance to the home leads directly onto the main road through the village making independent access to the village difficult for most residents. The mobile library service visits the home but there are few other local amenities. Care Homes for Older People Page 3 of 13 What we found: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The reason for this visit was to undertake a random inspection following the key inspection of 11th July 2008 when we made six requirements relating to care planning, the management and storage of Controlled Drugs, the environment and staffing levels and staff recruitment. An Immediate Requirement was issued following this key inspection with regard to staffing levels in the home. The proprietors were required to confirm in writing within 24 hours of receipt of the Immediate Requirement what action they planned to take. A response was received on 17th July 2008 with copies of staffing rotas for the weeks beginning 14th, 21st and 28th July 2008. A copy of the Assessment of Needs of the residents was to be sent Recorded Delivery. The Commission for Social Care Inspection did not receive this document. Subsequently a Safeguarding Alert was raised by Essex Social Services on 22nd September 2008. The concerns raised were in line with the requirements found at the key inspection, with an additional concern relating to the nutritional needs of the residents. At this random inspection we looked at care plans, the management and storage of Controlled Drugs, the environment, with particular attention to the laundry facilities, nutrition, staffing levels and staff recruitment practices. We looked at the care plans of three people living at Brick Barn. We had looked at these care plans at the key inspection on 11th July 2008. Very little had changed since that date. All three care plans had a care plan summary record only. The headings Condition - Objective - Action were listed in this summary, but the information found under these headings was limited and did not detail the action which needs to be taken by care staff to ensure that residents health, personal and social care needs are met. For one resident a review date for the care plan summary had been set for 30th September 2008. There was no evidence of a comprehensive care plan. Blank care plan sheets were found on file for completion, but none had been completed. Within the remaining two residents files, a care plan summary or a care plan were not found in the designated section of the file. In each case the completed care plan summary had been moved to the rear of the file. We were told that this was because they were due for review early September 2008. Neither had been completed and as with the other file inspected there was no evidence of a comprehensive care plan. We looked at the medication records and storage with regard to Controlled Drugs. The home continues to use the Boots Monitored Dosage System (MDS). Since the key inspection, the home has introduced a Controlled Drug register. We were informed that a Controlled Drug cabinet is on order from the homes pharmacist. Two people were having or had had the Controlled Drug Temazepam. This medication was held in a cash tin which was held in the Medication Trolley. Medication was being adminstered by care staff from Essex County Council, for none of the present homes care staff have been trained to give medication. We were informed that a medication administration training course was booked for Thursday 2nd October 2008. Care Homes for Older People Page 4 of 13 The record keeping with regard to Controlled Drugs was muddled and confusing. One resident who was recorded as having a medication review on 11th September 2008 was stated as having an increase of dosage of Tamazepam at night for the following three weeks. However, nothing had been given from 7th September to 19th September 2008 when an audit of medication held had been conducted by Essex County Council. For the second person on a Controlled Drug, the record keeping was poor and irrational, with some recordings on the Medication Administration Record (MAR) sheet and only two entries made in the Controlled Drug register. An audit of this Controlled Drug has been completed on 19th September 2008, but once again there had been confusion as to the quantity of Tamezepam held in the home for this resident. This was discovered at this random inspection and an updated audit was completed by a carer and the proprietor. This was noted in the Controlled Drug register. Whilst our concentration was on the management and storage of Controlled Drugs, it was evident from the Safeguarding Alert raised by Essex Social Care that the management and record keeping relating to medication had either ceased or declined since 7th September 2008 when the homes manager had handed in their notice. This is very concerning and it gives us concerns regarding the safety and care of all residents. Concerns were raised in the Safeguarding Alert around the home meeting the nutritional needs of the residents. The availability of fresh produce, the choice of meals offered and food hygiene practices in the home were raised as concerns. On our visit we saw that daily menus were in place. The cook was able to show us menus dating from 2nd September 2008. They said that whilst there was a planned 4 week rotation menu, they were not following that, preferring to plan the meals each day. They told us that whilst there is only one choice detailed on the menu, residents are offered an alternative option. On the day of the random inspection, they said that they had offered each resident a choice of pizza or a meat dish as they had settled down for the meal. We found from the nutritional records that the majority of times, the residents had the same option. Records were kept of food eaten at each meal by each resident. However, these were lacking in detail i.e. veg. and sandwich were noted with no detail of what vegetable or sandwich was offered. We looked at the food supplies in the home. There was little evidence of fresh vegetables. There were some onions and an opened sack of potatoes. No fresh fruit was seen in the home. There was a selection of dry, tinned and frozen foods. Frozen food in the two feezers consisted of frozen convenience foods such as pies, gateaus, meat and fish dishes and pizzas. Bread and milk was seen in the fridges and freezers. We asked the cook in the kitchen if they had a basic food hygiene certificate. They told us that they did not. They told us that they had been employed at the home for approximately 6 weeks. They had been taken on as a cleaner, but as the cook had left they had been asked to cook. They said that they understood the cook was due to return soon and they planned to leave the home in October 2008. We saw a record sheet for recording fridge and freezer temperatures. The proprietor told us that old record sheets had gone missing and following a visit by the Environmental Health Officer (EHO) the home had recommenced recording these temperatures in the morning and after lunch. The cook asked a carer to do this for her Care Homes for Older People Page 5 of 13 as she left the home after lunch. At this visit we undertook a partial tour of the premises. This was to see what changes and improvements the proprietor had made since the last inspection. There were no unpleasant odours in the home at the time of our visit. A new stair/chair lift has been installed. It was not seen to be used by residents during our visit; for residents were seen to walk up and down the stairs. Two new dining room tables and 8 chairs have been installed in the dining room. Whilst this is seen as an improvement, the home still does not have sufficient seating for all of the residents to sit in the dining room should they choose to do so. A first floor toilet has been converted into a wet/shower room. The proprietor said that it was not fully completed for attention was required to the door hinges. It was a stark and clinical. Since the key inspection, an EHO has visited the home. The proprietor said that they had visited the previous day and they awaited their report. They anticipated that the recommendations made would be complied with in the timescales given. We understand that the recommendations will relate to Food Hygiene practices and Health & Safety matters. At the time of this visit, builders were in the home converting a first floor bathroom into a laundry. The ground floor laundry was still in use and as found at the key inspection, this was in a poor state of repair. The wall and floor surfaces were damaged and they were difficult to keep clean and they were therefore likely to be a problem with regard to infection control. The proprietor said that the existing washing machine had been repaired and was back in use. They said however, that it was on its last legs and therefore the home continues to use the washing machine in the bungalow at the rear of the property. This practice continues therefore to raise concerns with regard to infection control arrangements in the home, especially as the present washing machine does not have sluicing programme. Staffing levels in the home had been supplemented by Essex County Council staff since Friday 19th September 2008 when a Safeguarding Alert was raised. The Proprietor told us that the manager had resigned and they had left the home on Friday 19th September 2008. At this random inspection, two carers from Essex County Council were planned on the rota throughout the day. The proprietor told us that the local authority carers were working in the home until Friday 26th September 2008. In addition the home has recruited staff from an agency and bank staff were being contacted to return to work in the home. Furthermore care staff and management from a home which had recently closed were being recruited to work at Brick Barn. At this visit we took copies of staff rotas for the week beginning Monday 22nd September and Monday 29th September 2008. These were collected under a Notice issued in accordance with paragraph 6.7 of Code B of the Police and Criminal Evidence Care Homes for Older People Page 6 of 13 Act 1984. The proprietor said that these rotas were only provisional and they were incomplete. We found that there was no evidence of an assessment of care needs of the residents to calculate the staffing levels required and whilst some staff were planned to be working with only a POVA 1st check, no supervision arrangements were evident. In addition to care staff a cook was detailed for each day 07:00 - 15:00 hours of the week commencing 29th September 2008. No cook was detailed in the afternoon or evening shifts. For the previous week the rota commencing 22nd September 2008 had no cook on duty on 22nd, 23rd, 24th and 28th September 2008 and no additional cleaning or domestic staff were detailed on the rota throughout the two week rotas. Staff recruitment paperwork for five carers who had made an application to work at Brick Barn were inspected. All five of these carers had worked at the home which was closing. A further three staff files of carers at Brick Barn were inspected and the paperwork for three agency staff members were seen. Overall, we found poor recruitment practices in the home. There were shortfalls in employment histories, with dates and details incomplete, some references had not been taken up and Criminal Record Bureau (CRB) disclosure were not completed for new staff. None of the current carers working at the home had copies of terms and conditions and there was no evidence of induction training on file for established or new carers. What the care home does well: What they could do better: None of the Statutory Requirements including the Immediate Requirement were found to be met in full. Improvements must be made to care planning and the management, record keeping and storage of medication including Controlled Drugs. Whilst some environmental issues found at the key inspection have been attended to, namely the installation of a stair/chair lift, the management of laundry and infection control issues remain. Nutritional needs to be considered in more detail. The lack of choice and fresh produce is concerning. Trained catering staff with planned menus to ensure that residents are offered a nutritious, wholesome meal are required. Staffing levels remain a concern. Whilst the home has had an in put from Essex County Council staff, the recruitment practices, induction and supervision of new staff Care Homes for Older People Page 7 of 13 have not been considered. Furthermore dedicated catering and domestic staff are needed in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 7 15(2)(b)(c), Schedule 3 (1)(b) People living in the home 22/08/2008 must be assured that all of their care needs will be set out with reference to identified detailed risk assessments in an individual care plan which details the action to be taken by care staff. These care plans must be appropriately frequently reviewed. So that people receive the care required to ensure all aspects of their health, social and personal care needs are met. 2 27 18(1)(a), 19 People living in the home 11/07/2008 must be assured that at all times there are suitably, qualified, competent and experienced staff working in the home in such numbers as are appropriate to meet the needs of residents. This is the subject of an Immediate Requirement Notice. So that people living at the home are assured that their needs will be met. 3 29 19(4)(c), 12(1)(a) People living in the home 22/08/2008 must be assured that they are safeguarded by thorough staff recruitment processes Care Homes for Older People Page 9 of 13 of all staff. So that people living at the home are assured they are safe. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Complete and accurate records must be kept of all medicines given to people. So that people receive the correct medication. 29/10/2008 2 9 13 Controlled Drugs, including 29/10/2008 Temazepam, must be stored in a Controlled Drug cupbaord, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. In order to comply with legislation. 3 15 16 People living in the home must be assured that they receive a wholesome, and nutritious diet. So that they are assured of good health. 29/10/2008 4 26 16 The homes laundry must be fit for purpose, clean and operating under infection control legislation. So that the home is clean and people are safeguarded 29/10/2008 Care Homes for Older People Page 11 of 13 from infection. 5 27 18 The home must ensure that 29/10/2008 at all times there are suitably, qualified, competent and experienced staff working in the home. So that people living at the home are assured that their needs will be met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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